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ERMITTEE NAME:/AODRESS 4weLlr feerAlry N~t/lacrlen I/DfQfww.r) NATIONAL POLLUTANT OISCNMOE ELIMINATION SYSTEM (IVPOESI <br />NAME DISCHARGE MONITORINt REPORT ID Rl <br />ADDRESS -. <br />$O~; i ;'~: PERMIT NUMBER dsCHMOENUMDfF <br />I'A MONITORING PERIOD <br />FACILITY Piu. 3 i`1 ~ ~ a~- <br />YEAR MO DAY YEAR MO OAY <br />LOCAT1oN R Sc i O ~-'• FROM TO <br />i T i^J )= T•1Fa1R . PRF.c.T f)~i <br />Form Approved <br />OMB No 2040-0004 <br />~,. ii r: ~ ,,-. <br />F - c i Pi;aL. bU <br />'93Pic 7Rr~IPiAt3c TO P; Fig vuivNlSt7Pi <br />NOTE: R~sd Imt-vctloM b~for~ compbtlnp this tam. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION f~0, rREOUENCr SAMPLE <br /> <br />EX oc <br />TYPE <br /> ANALrsls <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT , <br />.~ <br /> PERMIT r , ~ , -; }i- L`~ ;; :. to -=r ._ t , _ ~ S <br /> REQUIREMENT f•i i ._ -,. '=t X I ;~i'„'I ; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT 3i z; ._ .- :: is ?i +. i ~ • >,- fi i <br /> .REQUIREMENT :'s~1i u~=,-it_ i=tX <br /> SAMPLE <br /> MEASUREMENT Ic- <br /> <br /> REQUIREMENT ;SOU:=; ~1', 1=i:i ~":- <br /> SAMPLE <br /> MEASUREMENT ^" <br /> PERMIT ~- . Vii. ### .~,..;. r: #ie#- .... , , ~~ <br /> REQUIREMENT ~~ rt`i i <br /> SAMPLE <br /> <br />-;;_;. r;.~~(.~ ; ~ MEASUREMENT ~~ <br />.? t ~~ ~'? PERMIT ~.;_, u t . ;_~ :: - ;r._ t. T .c=~r:~ > ~?• <br /> REOUIREMENT !~ ~`,IL_Y i`7r <br /> SAMPLE <br /> MEASUREMENT <br />,~ <br />. PERMIT ~ -" ~ is rr, r:-.; - ~: v ,~_ <br /> REQUIREMENT` ~?RT' -. '.~-yILY ~3X <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT _~ : , . . <br />REQUIREMENT i~T hla!::; <br />NAME/T1TLE PRINCIPAL EXECUTIVE OFFICER I certll) ° rr pene~l~w IAe1 Ihh dorvmeM erd ell ellechlrs:nb were TELEPHONE DATE <br />prepared under mr dlrtcllon a tuper+tyon In etrnrdenct wllh . t7stem deef~ned <br />to more IMI t/uellfkd personnel PrWe~l Le1Mr end erehelt the Inferenellon <br />wlbmllled. 6eeed on mT InQulry of the person or persar who orange IM ryttem, <br />er Ihose penern dl recur rapenalbit for pthMnS the Infornutlorti the Inrormellon <br />~ ~ ~ <br />submllted b, to the bat of Im knowledEt end beMel, troe, eccunle, end tompkle. <br />~ ~ <br />dM1UM <br />- 1 ein aware that 1Aere ere tl <br />eneltb ror <br />brrrltin <br />f10NATVRE OF fMtINCIPAI EXECIlT1VE <br />r <br />b <br />I <br />f <br />p <br />~ - I <br />- <br />TYPED ~ PRINTED t <br />~ <br />p <br />a <br />o <br />e <br />n <br />orrne <br />orl, <br />Includln~ the potdbllll~ Drone end Inrpr4sonenenl ror knowln~ rldethntt OFFICER OR AUTHORIIEO AoENfT A A <br />CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION Of ANY VIOLATIONS /R~f~r~nc• a.N •tr~chm~nts h~iol <br />~R <br />EPA Form 3320.1 (Rev. 3!99) Prev,ous editions may be used <br />iT MON1•H!_Y AVERAUE DtJR ING PERIOD REPOR <br />This is a 4-part form. PAGE c <br />